May 08, 2020, 10:00 AM
ZSMICHAEL^^^^^^^^^^
The order does not prohibit gardening or the sale of any particular product in Michigan. Stores in Michigan larger than 50,000 square feet must close areas for garden centers and plant nurseries, as well as those that sell carpet or flooring, furniture and paint.
Again we have a poorly written governmental directive.
May 08, 2020, 11:02 AM
PASigquote:
Originally posted by frayedends:
Some god news in Massachusetts. A judge declared gun stores must be opened. Basically said our governor’s closure put an undue burden on constitutional rights.
Damn, I didn’t realize some of you were in that boat still.
Dictator Tom Wolf of Pennsylvania tried that shit on March 19 and was forced to allow gun stores to re-open by April 1 or so. They are appointment-only at this time but we were able to resume buying guns. I bought a Kel-Tec PF9 the next day as a big fuck-you to him.
May 08, 2020, 03:16 PM
ZSMICHAELI debated whether to start a new thread on the mental health effects of social distancing and the quarantine.
Thus far there has been little discussion beyond the frustration at the various pronouncements by Governors who seem enchanted with their own power.
I did note that liquor sales nationwide have doubled since the lockdown. I suspect working from home for some people involves enjoying their cocktails all day long. Domestic violence calls are way up according to police. Compulsive handwashing for some has escalated as fear of catching the virus is constantly mentioned. Isolation for those in nursing homes was already a problem, and now no visitors.
People are also missing regular checkups for cancer followup and the like.
May 08, 2020, 05:13 PM
ZSMICHAELThe powerful sedatives necessary to save coronavirus patients may also lead to a difficult recovery
After a well-earned break following six weeks treating coronavirus patients in the University Medical Center ICU, Dr. Kyle Happel, a pulmonologist and critical care medicine specialist at LSU Health Sciences Center, can't help but "chart-stalk" some of his former charges.
"You're just dying to know if they're doing well, are they still alive,” said Happel.
Many of the people he treated were on ventilators, which means that a large percentage were likely to succumb to the disease. But for those that make it, a long recovery in the hospital is likely to become an even longer recovery at home due to the excessive time spent on narcotics and breathing machines.
During normal times, patients in the ICU might stay on a ventilator for three or four days. But it is not unusual for coronavirus patients to stay on ventilators for a week or two – or, in some cases, a month or longer. And those patients are requiring massive amounts of sedatives, painkillers and paralytic drugs.
Drug trials, fewer ventilators: here's how Louisiana’s coronavirus treatments have evolved
Drug trials, fewer ventilators: here's how Louisiana’s coronavirus treatments have evolved
“The amount of sedation required to help people is astronomical and unlike anything we’ve ever seen,” said an Ochsner ICU nurse with decades of experience, who spoke on condition of anonymity because she was not authorized to speak by her employer.
For patients who spend a month or more in the ICU on unprecedented doses of drugs, the physical and mental toll of coronavirus often results in delirium – and doctors worry about the long road to real recovery. Even if coronavirus doesn’t kill patients within weeks, they could live with the effects for years.
“A lot of these folks will not be able to return to the same level of daily functionality or daily living,” said Happel. “Many times they are not going to be the same people they were before. Some might require placement in long-term acute care or skilled nursing facilities. Some may require dialysis. In survivors, there will be significant morbidity.”
According to the largest mortality study of patients with coronavirus on ventilators, the majority who go on the ventilator do not come off. Among 98 ventilated patients in the U.K., only 33 were discharged.
Other studies are even more sobering. In a small study out of China, 19 of 22 ventilated patients died.
The ventilator itself is dangerous for patients. While it can be a life-saving measure, staying on it for too long can cause complications.
“I tend to think of the ventilator as a race,” said Happel. “It’s a race for you to get off before you develop a complication: lung injury or pneumonia.”
As coronavirus patients linger on ventilators, they develop a tolerance to the drugs that allow them to permit having a plastic tube down their throat.
Fentanyl, a synthetic opioid used as both a sedative and a pain manager, has been essential.
“We used metric tons of it,” said Happel.
Some hospitals, such as Our Lady of the Lake in Baton Rouge, relaxed maximum dosing allowances for nurses because so many patients were requiring higher levels of medication.
'It’s horrendous': Louisiana coronavirus patients' final moments are often without loved ones
'It’s horrendous': Louisiana coronavirus patients' final moments are often without loved ones
"Patients are on the ventilators longer than we typically have," said Bud O'Neal, the hospital's medical director of research.
And the longer time on ventilators leads to a patient becoming accustomed to the narcotics necessary for their treatment.
“All of the opiates – fentanyl, morphine, deltoid – patients can develop tolerance,” said O'Neal, who said the hospital is still treating patients that came in during the first wave in late March. “Sometimes we do have to continually go up on the patients.”
Doctors try to give patients the bare minimum of medication in the ICU, because the powerful opiates and other narcotics are addictive and are not meant to be used long-term.
The dependency can lead to withdrawal when patients are able to slowly come off the ventilator, another difficult battle.
In March, demand for sedatives, paralytics and pain drugs surged 73% nationwide, according to Vizient, Inc., which negotiates drug prices for hospitals throughout the country. With so many patients on ventilators, hospitals in Louisiana faced shortages, too.
When the Ochsner ICU nurse tried to get fentanyl from the pharmacy, she would get a message back: “It would say there is a critical shortage and they would give you alternatives.” Instead, she and her colleagues used a more potent form of fentanyl, then switched to Dilaudid, another opiate.
"Collaborative teams ... worked together to develop treatment protocols for multiple scenarios and equal alternatives for all medications needed," according to a statement from Ochsner Health emailed by the hospital's public relations team.
Beyond withdrawal, patients also have a much higher risk for post-intensive care syndrome, a series of health problems that follow a prolonged stay. One in three patients in the ICU experience delirium, making it difficult for them to eat, sleep, think or remember where they are. The effects of high levels of sedation for a long period of time may play out for years, said Dr. E. Wesley Ely, a pulmonologist and critical care physician at Vanderbilt Medical Center.
LINK:
https://www.nola.com/news/coro...96-f3a3d514362c.html